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� PERMIT APPLICA i ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 -FAX 425-257-8857 <br /> SITE ADORESS ���� �Qy . PARCEL TAX I.D. k PERMIT N <br /> o3os -ot3 <br /> LEGA LOT NO. BLOCK TRAQ� <br /> DESC. <br /> OWNER AODRESS LI�P PHONE <br /> (,�, �/f iu.-7Xi/�. 2 9�D 1.�..���tU, �.c�i��'i�', 9AZa/-�J2S,zs7-S9 <br /> r� <br /> TENANT NAME / � �y� I CONTACT FOR PERMIT PNONE <br /> (� I C-Cl���(_/ <br /> CONTRAC OR �,N � �_ . .rADDRESSZ�/O� J`� x ZIp CONTR.LICEN9E <br /> f'tj'Js/ V�9NAac'�2l�4!/�- <br /> PNONE J�.7 S ` 2�Z` I y`'�� <br /> PROPOSED USE OF BUILDIN6 Bullding � MechanlCel AddlOon HEAT 80URCE <br /> TYPEIT B cpr�kl���^on Si�un bin9 n,EK �RePelr/Malnt. � Olher c <br /> CONTRACT PRICE OF WORK ��� J5 v � �j CITY OF EVERETT LOCAL 8ALE9 TAX CODE 19 9106 <br /> WORK DESCRIPTION (�Jy��1 ly� l f'�i �. <br /> , r.�l' 6�«. /B�n Sh✓ -<-�.�-T-.z.-�T�¢�. <br /> ,.!>ua.�.�+�-c_...�_.c .-._.T�.y� �JeY�-�) �L`+l.r- - �� <br /> ✓ <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> �/ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES ORYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY �✓ATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AMD KNOW THE SAME TO BE TRUE AND CORRECT, qLL <br /> PROVISIONS OF L4W5 AND OFIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER S�ECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMiT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRAC ORS LAW 1827 RCW AND 296.200 WAC. <br /> .1r�-<-����.����-,� .�G�'—G3 <br /> Signature of O dContractor/Authonzed Agent ate �� <br /> DEBIT � CREDIT CARDS ARE NOT ACCEPTED Z <br />